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In Reply.—Spritzer and Sauer report their experience with an indomethacin regimen that includes higher doses and a shorter dosing interval. The clinical response appears to be somewhat better than that achieved in our study. Because of our disappointing clinical results, we altered our indomethacin administration protocol to achieve therapeutic serum indomethacin levels greater than 500 ng/dL over a period of five to seven days. Indomethacin was administered daily using a dosage schedule adjusted according to the serum indomethacin level. Thus far, 21 premature infants weighing between 700 and 1200 g have been treated in this manner. The results are similar to those we reported with a more standard drug administration regimen. Initial constriction or closure occurred in 19 (90%) of 21 infants, but ductal reopening occurred frequently, and eventually nine (43%) of 21 infants required ductal ligation. Thus, it appears that long-term administration of indomethacin is no more efficacious than short-term
MURPHY DJ. Treatment of Patent Ductus Arteriosus With Indomethacin-Reply. Am J Dis Child. 1988;142(2):126-127. doi:10.1001/archpedi.1988.02150020020014